CONFIRMED MINUTES OF THE SOUTH WEST REGIONAL TRANSFUSION COMMITTEE Attendance: NHS HOSPITALS Derriford Hospital Dorset General Hospital Gloucestershire Hospitals Great Western Hospital North Bristol Trust North Devon District Hospital Poole General Royal Bournemouth Royal Cornwall Hospital Royal Devon & Exeter Hospital Royal United Hospital Bath Salisbury Taunton and Somerset Hospital Torbay Hospital University Hospitals Bristol Weston General Yeovil District Hospital Friday 18 May 2012, 10:30 15:30 Oake Manor Golf Club, Nr. Taunton Sophia Wrigley (SW), Paul Moor (PM), Sam McAleer (SM) David Quick (DQ) No Attendance Maria Davies-Smith (MD) Janet Birchall (JB) Maggi Webb (MW) Alison McCormick (AM), Sue Redfearn (SR) Shane McCabe (SM) Stephen Bassey (SBas), John Faulds (JF) James Piper (JP) No Attendance Phil Donnison (PD) Sarah Allford (SA), Matthew Barnett (MB), Alison Western (AW), Sam Yuen (SY) presentation only Patrick Roberts (Chair) (PR), Alistair Penny (AP), Tom Latham (TL), Soo Cooke (SC) Louise Jefferies (LJ) No Attendance PENINSULA REGISTRARS Derriford RD&E / Torbay PRIVATE HOSPITALS BMI Bath Clinic Nuffield Health Cheltenham Hub Nuffield Health Exeter Hub Spire Hospital, Bristol Somerset Community Health Patient Representative NHSBT Customer Services Manager Transfusion Liaison Nurses Transfusion Registrars Data Analyst & Audit Manager RTC Administrator Yin May Thi, Anna Clowley, Sarah Poplar Eve Molnar / Kathy Clarke No attendance Mary White (MW) No attendance Bernadette Jones (BJ) No attendance Bob Lang Elaine MacRate (EM) Peter Thompson (PT), Alister Jones (AJ) Karan Wadehra (KW), Heather Eve (HE) Brian Hockley (BH) Jackie McMahon (JM) Minutes of SW RTC Meeting 1 18 May 2012
1. Apologies: Attached. 2. Previous Minutes: The minutes of the meeting held on 21 November 2011 were confirmed as a true and accurate record. 3. Matters Arising 3.1 4.1 Wastage & Issue Data Potential changes to how adhoc data is presented are covered in 4.1. All hospitals have agreed to deanonymisation of adhoc delivery data. 3.2 10.2 Results of 2011 Database Survey There was found to be no correlation between the introduction of electronic tracking in hospitals and a decrease in RBC issues. 3.3 14. AOB The document, originated by RD&E, outlining the role of a consultant lead for transfusion will shortly be available on the RTC website. 4. Questions from Circulated Documents (All) 4.1 Adhoc Data EM confirmed that agreement had been given to change the way that the data is presented and put forward some suggestions: - is this data wanted / is it collected by hospitals already - show % of deliveries carrying platelets - split into weekend and weekday deliveries - show out of hours deliveries (decide cut-off for out of hours ) EM reminded everyone that this data was not issued for benchmarking purposes but to highlight the number of deliveries for individual hospitals to review and reduce if appropriate. Following discussion, it was agreed that the RTT would review the data and consider how best it could be split. Action: RTT 4.2 KPIs There were no KPIs to review. All present confirmed they still wished to receive feed back on KPI data. 4.3 Wastage Data The data was briefly reviewed and JP commented that it was a good monitoring tool for hospitals. EM stated that NHSBT are doing work around the 10.5% O-neg. target and looking at why some hospitals use more than others. This may result in a change in the future. 4.4 Budget (2011/2012) A breakdown of expenditure was presented which highlighted a small under spend for the year. A quantity of blood bags/collection sets have been purchased and are available to hospitals for training purposes. Minutes of SW RTC Meeting 2 18 May 2012
5. BSMS Trend Analysis Data/Comparison of National & Regional Trends 2010-2012* (JB) [*All presentations are available on the RTC website] All present confirmed they receive / are aware of the BSMS trend data, which is a national version of our regional data and issued on a quarterly basis. JB highlighted that platelet issues in the south west have fallen, against the rising national trend, and noted that regional issues started to drop after the release of the platelet audit in May 2011. 6. Hospital Presentations 6.1 Taunton Team - Feedback from Major Incident* (SA, MB, AW) The Taunton team presented on their experiences following a major incident on the M5 motorway in November 2011. One major concern to emerge was a delay in delivery of components from Filton as the NHSBT van wasn t allowed on the motorway. EM to investigate further with NHSBT Transport and had SA s permission to pass her name on should they wish to contact her. Action: EM There was a discussion on alternative means of delivery when road links are compromised (although NHSBT has a process in place to deal with major incidents). SB mentioned that RCHT call on the ambulance service in such situations as they can call in the helicopter. EM to investigate if this could be done within NHSBT. Action: EM Transferring stock from other nearby hospitals was also discussed. EM said that although stock would be moved around within NHSBT, there is currently no access to information on what stock there is within hospitals. This may be remedied soon as there is now agreement from hospitals to share their stock data with NHSBT. The paperwork developed by T&SNHSFT for dealing with major incidents will be circulated with the minutes. No wastage of blood components occurred as a result of the incident as they were used in subsequent surgery. 6.2 Poole Blood Budget Saving* (SR) SR outlined how Poole identified and implemented measures to achieve savings on their blood budget. Future plans include charging users (this is seen as a big potential saving). She referred to their guidance for red cell use in Upper GI bleeds and welcomed feedback from other hospitals as to how they deal with these cases or any other comments regarding measures they have put in place to reduce blood component use/costs. 6.3 The Introduction of ROTEM to Derriford Hospital* (PM/SM) PM/SM presented on the introduction and use of Rotem at Derriford. Minutes of SW RTC Meeting 3 18 May 2012
7. National Blood Transfusion Committee Update* (PR) RTC Chairs Platelets various regional audits are taking place this offers a good opportunity to benchmark. National NBTC indication codes bookmark now available. Provision of platelet data in adhoc reports discussed. HTC Chairs survey plan to get more responses and discuss again. NBTC NPSA SPN 14 Review Group is recommending knowledge tests replace competency assessments to be considered by NBTC Executive Group Education Working Group is looking at transfusion training in England with a view to updating standards / producing recommendations. Blood components - not necessary to provide CMV negative components for transplant patients; NBTC not pursuing recommendation for universal non-uk FFP; prion filtration still ongoing awaiting data on effectiveness and will initially be for select groups. BBT Patient Blood Management launch on 18 June. Joint DH/ NBTC/NHSBT initiative aimed at reframing some of the BBT themes. NCA overview of current/planned audits. NHSLA considering removal of transfusion from the standards. AIM II participation encouraged to get patient level data on blood. ITS pilot sites now allocated for hub and spoke. Communication circulated inviting applications for pilot site for stock management. 8. Hospital Presentation Iron Optimisation at RCHT* (JF) JF outlined how RCHT successfully implemented their surgical blood conservation programme, with particular emphasis on iron optimisation/ anaemia management. One major factor in gaining funding from the Trust was the substantial amount to be saved by avoiding the late cancellation of planned surgery. Funding also received from Patient Level Intervention (paid for by primary care). More surgeons are now taking it on board in order to get patients as fit as possible pre-surgery. Future plans include involving the wider community so that GPs can buy into the service with treatment undertaken at home. 9. Audits/Surveys 9.1 Audit of G&S in RIF Pain* (SY) SY presented an audit carried out at Musgrove Park Hospital following the introduction of a guideline aimed at changing the practice of routinely performing a group and save on patients presenting with right iliac fossa pain, in the absence of any national/regional guidelines. Findings showed the guideline is not being followed and further work is needed. Although it had consultant agreement, it was felt that it was not being followed by younger, more junior staff. SY suggested that a regional guideline to provide consistency would be a desirable long term outcome. Minutes of SW RTC Meeting 4 18 May 2012
9.2 Feedback from Regional Platelet Use Survey* (AJ) AJ restated the reason for the survey, the survey questions and presented the preliminary headline results which confirmed haematology as the biggest user. 9.3 Review of Regional Massive Haemorrhage Policies* (PR) PR presented the results of his review of Massive Haemorrhage policies within the region (11 policies reviewed). 9.4 2012 Database Survey* (AJ) AJ outlined some minor changes that have been made to the 2012 survey. Agreement was given to SBas s request to include questions on which Laboratory Information System is in use and if it supports Electronic Dispatch Note. Action: AJ 10. Blood Conservation Group Update (JF) Following the inaugural meeting in October 2011, specific roles have been allocated to look at different areas, e.g. education. A major focus is the establishment of a local regional procurement group for IOCS consumables. Good feedback on SWBCG poster received at NATA. 11. Education Sub Group (AJ) The Midwives Study Day, held in October 2011, was very well attended with excellent feedback received. PT was thanked for his work in organising the event. Patient story has been updated with associated learning points. Good feedback from HCA study day follow up survey majority now more aware of safety issues around transfusion and are challenging poor practice. Plan to adapt this day for APs. Event on pre-op assessment and post-op management in terms of blood management being planned for late summer 2012. Learnbloodtransfusion (LBT) Update 8 courses now available following addition of learncellsalvage. Module on consent in last stages of development. Re-validation module for safe transfusion practice in final stages of development. Course on adverse events is being developed in parallel with BCSH guidelines. Safe Transfusion Practice and Blood Components Indications for Use are being reviewed as part of 2 yearly review process. Anyone with a NHS e-mail address can now access LBT through e-lfh (e-learning for Healthcare). Medical students can access via the foundation project on e-lfh; LearnPro access now being granted to universities & deaneries. Minutes of SW RTC Meeting 5 18 May 2012
12. TLM Update (MW) Stephen Bassey will be replacing Stephan Bates (retired) on the National Commissioning Group and Maggi will replace Stephen Bassey as the SW representation on the National TLM Group. Platelets on the van trial - uptake on the round selected was low. This is to be trialled again elsewhere on a busier urban round to see if there is any benefit. Updated guidelines for Compatibility testing to be released shortly SBas headed a debate suggesting that if a wider range of reagents was available, hospitals could reduce the work that needs to be referred to RCI department; no outcome. New transport boxes have been introduced to hospitals that are an appropriate distance from their blood centre. Labs. were asked to order AB platelets when needed (as these are sometimes available) and accept AB platelets when offered. Hospitals were asked to return haemolysed units and to inform CSM if any received with detached pilot lines. 13. TLN/TP Update TP group met on 26.04.12; included feed back from TP development day, latest developments in cell salvage and a new drug for the treatment of MDS. There is now to be three TP group meetings a year, and one conference-style day for TPs with a purely educational focus. PT handed over to Brian Hockley who has recently joined NHSBT to support clinical audit in the RTCs, working with John Grant-Casey. BH is aware of issues around over-auditing and bunching of audits, and that a more staggered approach is required. He will aim to co-ordinate activity more re: local audits and audits involving more than one RTC. 14. Any Other Business JB took the opportunity to ask BL (Patient Rep) if he had found the meeting useful. BL said he had, and intended to feed back on some of the discussion topics to other patient group meetings that he attends. The guest SpRs also commented that it was a very useful meeting. Alternatives to Blood Transfusion in Transfusion Medicine JB said that the RTC was considering purchasing copies of this publication and that if any hospitals wished to receive a copy, they should let JM know. DQ pointed out that the Olympics will also be impacting on the South West, with the sailing events at Weymouth. 15. Date of Next Meeting Thursday 22 November 2012 Minutes of SW RTC Meeting 6 18 May 2012
GLOSSARY OF ABBREVIATIONS AIM AP BBT BCSH BSMS DH FFP G&S GI HCA IOCS ITS KPI LBT MDS NBTC NCA NCG NHSBT NHSLA NLMS NPSA RBC RCHT RCI RIF RTC RTT TLM TP TSFT Appropriate Inventory Management Associate Practitioner Better Blood Transfusion British Committee for Standards in Haematology Blood Stocks Management Scheme Department of Health Fresh Frozen Plasma Group & Save Gastro-intestinal Health Care Assistant IntraOperative Cell Salvage Integrated Transfusion Service Key Performance Indicator Learnbloodtransfusion Myelodysplastic Syndrome National Blood Transfusion Committee National Comparative Audit National Commissioning Group NHS Blood and Transplant NHS Litigation Authority National Learning Management System National Patient Safety Agency Red Blood Cell Royal Cornwall Hospitals NHS Trust Red Cell Immunohaemotology Right Iliac Fossa Regional Transfusion Committee Regional Transfusion Team Transfusion Laboratory Manager Transfusion Practitioner Taunton & Somerset NHS Foundation Trust Minutes of SW RTC Meeting 7 18 May 2012
South West Regional Transfusion Committee Meeting Friday 18 May 2012 at Oake Manor Golf Club APOLOGIES Hospital Name BMI Bath Kathryn Robson Barnstaple Kathleen Wedgeworth Circle Bath Norjin Pejcic Emerson s Green NHS Claire Husain Treatment Centre Glos Hospitals Sally Chown Great Western Doug Smith Sally Caldwell North Bristol Karen Mead Lynda Davies Prospect Hospice Julie Dickens Royal Cornwall Carol McGovern Deb Thomas Richard Noble RD&E Biddy Ridler Veronica Samson Royal Bournemouth Julie Johnson RUH Jerry Nolan Sue Scott Salisbury Anne Maratty Somerset Partnership NHS Nina Vinall Foundation Trust SPIRE Bristol Vicky Fisher Weston Fran Dollery Yeovil Carla Newland-Baker Minutes of SW RTC Meeting 8 18 May 2012